=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962177816
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE GRAY AREA COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2021
-----------------------------------------------------
Last Update Date | 08/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W. WASHINGTON AVE STE 220
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-819-4538
-----------------------------------------------------
Fax | 870-617-0991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W. WASHINGTON AVE STE 220
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-819-4538
-----------------------------------------------------
Fax | 870-617-0991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | MRS. ANGELICA REINA GRAY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 870-819-4538
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------